儿童陈旧性孟氏骨折预后的影响因素以及肘关节Kim评分与Mayo评分的比较分析

Risk factors of pediatric neglected Monteggia fracture and Kim or Mayo Elbow performance score

目的对儿童陈旧性孟氏骨折术后患儿进行Kim评分及Mayo肘关节评分,探讨陈旧性孟氏骨折患儿预后的影响因素,为临床工作提供参考。方法统计自2010年1月至2018年12月中国儿童骨科多中心研究协作组收治的陈旧性孟氏骨折患儿基本资料,并进行术后随访,统计肘关节Kim评分及Mayo评分,采用SPSS 19.0对影响肘关节功能的因素进行统计学分析。结果本研究共统计陈旧性孟氏骨折患儿119例,随访90例(随访率75.63%),中位随访时间3.14年(6个月至8年)。术后Mayo评分等级为:优80例,良1例,可8例,差1例,优良率90%。术后Kim评分等级为:优71例,良3例,可11例,差5例,优良率为82.22%。二者评估结果无统计学差异(χ2=2.276,P=0.131)。影响肘关节Mayo评分的因素为:手术距受伤时间(χ2=13.188,P<0.001),是否行尺骨截骨(χ2=5.556,P=0.018);影响肘关节Kim评分的因素为:是否行尺骨截骨(χ2=4.331,P=0.037)。结论影响陈旧性孟氏骨折预后的主要因素包括受伤距手术时间以及是否行尺骨截骨,肘关节Kim评分及Mayo评分对患儿预后状况的评估结果一致性较好。

Objective To explore the risk factors influencing the recovery of pediatric neglected Monteggia fracture so as to provide rationales for clinical practice.Methods The basic data of 119 children of neglected Monteggia fracture from January 2010 to December 2018 were collected and postoperative follow-ups conducted.The Kim and Mayo elbow performance scores were calculated.Results A total of 90 children(male-to-female ratio:2:1)were followed-up.The median postoperative follow-up period was 3.14(0.5-8.0,±1.8573)years.The Mayo score after treatment was excellent(n=80),decent(n=1),fair(n=8)and poor.(n=1).Original injury to surgery interval and ulna osteotomy were risk factors(P<0.05)and the major factors were original injury to surgery interval and ulna osteotomy after logistic analysis(P<0.05).The Kim score after treatment was excellent(n=71),decent(n=3),fair(n=11)and poor(n=5).Original injury to surgery interval and ulna osteotomy were risk factors(P=0.05)and the major factors were original injury to surgery interval and ulna osteotomy based upon Logistic analysis(P<0.05).Conclusion The major influencing factors for the recovery of pediatric neglected Monteggia fracture include original injury to surgery interval and ulna osteotomy.No significant difference exists in elbow Kim or Mayo score.